Week 11: GI, Liver & Pancreas Flashcards

(64 cards)

1
Q

Define dysphagia

A

difficulty swallowing

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2
Q

Causes of dysphagia (4)

A
  • Disorders that produce a narrowing of the esophagus
  • obstructions d/t tumors inside or outside the esophagus
  • Lack of salivary secretion
  • Impaired esophageal motility
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3
Q

External causes of dysphagia (5)

A

compression of the esophagus by:

  1. enlargement of the L atrium of the heart
  2. aortic aneurysm
  3. abnormally formed blood vessels
  4. abnormal thyroid gland
  5. bony outgrowth from spine or cancer
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4
Q

Define esophagitis

A

inflammation of esophagus

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5
Q

Causes of esophagitis (3)

A
  • Eosinophilic
  • Infection - candida albicans, herpes simplex virus, CMV
  • Erosive: chronic acid reflux
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6
Q

Define Barrett’s esophagus, what does it usually lead to

A

intestinal metaplasia in the esophagus

typically leads to adenocarcinomas

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7
Q

Define hiatal hernia

S/S related to hiatal hernia (5), causes (4)

A

protrusion or herniation on the upper part of the stomach into the thorax through a tear or weakness in the diaphragm
S/S: chest pain, SOB, heart palpitations, discomfort swallowing food, acid reflux/heartburn
Causes: obesity, constipation, smoking, pregnancy

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8
Q

Define GERD

S/S related to GERD (2), causes (6)

A

backflow of gastric or duodenal contents or both into the esophagus past the LES
S/S: acute epigastric pain, heartburn
Causes: food/alcohol/cigarettes, hiatal hernia, increased abdominal pressure, medications, NG intubation, weak LES

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9
Q

How does smoking increase the risk of developing GERD? How does obesity?

A

Smoking: relaxes the LES
Obesity: increased abdominal pressure

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10
Q

Define gastritis, causes (5), s/s (5)

A

inflammation of the stomach
Causes: infection, stress, injury, drugs, immune disorders
S/S: abdominal pain, indigestion, bloating, N/V, pernicious anemia

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11
Q

Identify: exposure (2); infection; and genetic disorder (2) related to gastritis.

A

Exposure: gastric banding surgery, trauma
Infection: H.pylori
Genetic disorder: Type I diabetes, Hashimoto’s

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12
Q

Define gastroenteritis; identify two causative agents; and explain the role of inflammation in this process. What are indicators of inflammation; and what are typical clinical consequences of gastroenteritis?

A

inflammation of the GI tract, mostly within small intestine, also of the stomach
Causative agents: bacterial or viral infections - rotavirus, e. coli and campylobacter jejuni
Indicators of inflammation: evidence of blood in the stool
Clinical consequences: dehydration

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13
Q

Define irritable bowel syndrome

A

non-inflammatory type disorder, also known as spastic colon or spastic colitis, disorder of entire digestive tract causes recurring abdominal pain and constipation or diarrhea

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14
Q

Underlying cause of IBS
Prevalence
Triggers
Benign or Malignant?

A

unknown, may involve motor disturbances and reaction to distension irritants or stress
Prevalence: common, twice as common in women as men
Triggers: A variety of substances and emotional factors
Benign - no anatomic abnormality

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15
Q

Define inflammatory bowel disease

Patho

A

general term for chronic inflammation of the GI tract

Patho: chronic inflammation results in neutrophil infiltration, ulceration, development of fibrosis

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16
Q

Causes of inflammatory bowel disease
Sx (3)
Tx (1)

A

unknown, associated with genetic, infectious, immunological or psychological factors
Sx: bloody diarrhea, abdominal pain, weight loss (due to malabsorption)
Tx: termination of inflammatory response/promotion of healing

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17
Q

Define Crohn’s disease, what layers are affected?

What is a complication that can occur?

A

regional enteritis or granulomatous colitis, chronic inflammatory process that can affect any part of the GI tract

affected layers: affects all layers

Complication: fistula or abscess formation and intestinal obstruction

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18
Q

What disease process are skip lesions and cobblestone associated with?
Define each

A

Crohn’s
Skip lesions: demarcated granulomatous lesions that are surrounded by normal-appearing mucosal tissue

Cobblestone: fissures and crevices cause a cobblestone appearance to the surface of the mucosal layer

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19
Q

Define Ulcerative Colitis, what layers are affected?

What is a complication that can occur (3)?

A

inflammatory disease of the colon and rectum, produces edema and ulcerations

affected layers: usually affects mucosa only

Complications: perforation of the colon, fatal peritonitis and toxemia, increased r/f colon cancer

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20
Q

Characteristics of ulcerative colitis

A
  • Inflammation is consistent and confluent across the surface
  • May see small, focal crypt abscesses that become necrotic and ulcerate
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21
Q

Causes, Sx, Tx of Ulcerative colitis

A

Causes: unknown, may be r/t abnormal immune response in colon
Sx: constant diarrhea mixed with blood
Tx: reduce acute manifestations, prevent recurrence, avoid irritants

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22
Q

Define nausea vs. vomiting

A

Nausea: urge to vomit that may occur independently of vomiting or may precede or accompany it

Vomiting: forceful expulsion of gastric contents, increases intra-abdominal pressure along with relaxation of LES causes return of stomach contents to the esophagus and mouth

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23
Q

Define anorexia

A

loss of appetite or lack of desire for food
Nausea, abdominal pain and diarrhea may accompany it
May result from dysfunction of GI system or other cause

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24
Q

Distinguish between: osmotic and secretory diarrhea and identify one cause of each

A

Osmotic: Hyperosmotic luminal contents whereby a nonabsorbable substance in GI tract shifts the osmotic balance so that water is drawn into the GI tract - lactose intolerance

Secretory diarrhea: secretory processes increased - Zollinger-Ellison syndrome

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25
Define constipation and explain how: dehydration, lack of exercise, medications can cause constipation.
define: infrequent, incomplete or difficult passage of stools
26
Define normal-transit vs. slow-transit constipation
Normal-transit: perceived difficulty in defecation, usually responds to increased fluid and fiber intake Slow-transit: characterized by infrequent bowel movements and is often associated with alterations in intestinal innervation
27
What typically causes disorders of defecation?
Causes: dysfunction of the pelvic floor or anal sphincter
28
Define intestinal obstruction and explain/give an example of mechanical (1) and non-mechanical obstructions (3).
Intestinal obstruction: partial or complete blockage of the lumen of the small or large bowel Mechanical: foreign bodies such as fruit pits, gallstones or worms Non-mechanical: paralytic ileus, electrolyte imbalances, toxicity
29
What is the connection between adhesions; strangulation; and tumors and intestinal obstruction?
○ Adhesions and strangulated hernias usually cause small bowel obstructions Tumors: carcinomas usually cause large bowel obstructions
30
How can obstruction result in shock?
can occur if obstruction is untreated
31
Define diverticulosis and identify two causes.
inflammation of diverticular or herniation within the wall of the intestinal tract, accompanied by an inflammatory response usually in sigmoid colon Causes: - intraluminal pressure: chronic constipation, obesity - Inflammation: bacterial infection and undigested food
32
Define peritonitis and explain GI causes (5) and GU causes.
inflammatory response of the serous membrane lining the abdominal cavity and covering internal visceral organs GI causes: perforated peptic ulcer, ruptured appendix, perforated diverticulum, gangrenous bowel or gallbladder GU causes: PID
33
Define malabsorption syndrome
alteration of ability of intestine to absorb nutrients
34
How are each of the following related to malabsorption: cystic fibrosis; celiac disease; inflammatory bowel disease
CF: thick mucus surrounding organs can lead to poor absorption Celiac disease: immune-mediated disorder triggered by ingestion of gluten-containing grains Inflammatory bowel disease: inflamed mucosa more difficult to properly absorb nutrients
35
How can malabsorption cause anemia; steatorrhea; and edema?
anemia: decreased B12, iron, folic acid), steatorrhea: decreased fat absorption edema: decreased protein absorption
36
Definition/causes/sx of Upper GI bleed Definition/sx of Lower GI bleed Definition: occult bleeding
Upper GI bleed: esophagus, stomach, duodenum Causes: bleeding varices, PUD, esophageal tea Sx: hematemesis, melena (dark, tarry stools) Lower GI bleed: jejunum, ileum, colon or rectum Sx: hematochezia (frank bleeding from rectum) Occult bleeding: usually slow chronic blood loss
37
Define jaundice and explain the differences between pre-hepatic; hepatic; and post-hepatic jaundice and give one example of each type of jaundice.
Jaundice: yellow or greenish pigmentation of the skin, sclerae and mucous membranes caused by hyperbilirubinemia Pre-hepatic: may be caused by genetic diseases including sickle cell anemia, thalassemia, glucose-6-phosphate dehydrogenase deficiency, hemolytic uremic syndrome Hepatic: dysfunction of the liver's ability to process bilirubin for elimination; commonly caused by hepatitis or cirrhosis Post-hepatic: problems related to passage of bile through bile ducts that results in obstructive jaundice; commonly caused by gallstones or pancreatitis/pancreatic cancer
38
How does neonatal jaundice occur?
Neonatal jaundice caused by impaired uptake/conjugation of bilirubin as enzymes not present at birth
39
What is the normal role of the liver in biotransformation; what generally happens in phase I and phase II reactions?
Biotransformation: detoxification of drugs or alcohol, reactions that convert lipid-soluble or nonpolar molecules into water-soluble or polar substances to facilitation excretion and elimination from the body Phase I: chemical modifications - cytochrome P450 system Phase II: conjugation with glutathione
40
Define hepatitis, causes (4)
Hepatitis: inflammation of the liver Causes: infection, alcohol abuse, drug intoxication, autoimmune processes
41
What is the most common cause of drug-induced liver damage?
Acetaminophen
42
What is nonalcoholic fatty liver disease? What are underlying conditions associated with NAFLD (4); and a common mechanism that underpins these conditions?
Nonalcoholic fatty liver disease: fatty liver disease that has the potential to progress to cirrhosis and ESLD arising from causes other than alcohol abuse Associated underlying conditions: Type 2 diabetes, obesity, metabolic syndrome, hyperlipidemia Common mechanism: unknown, appear at least in part related to insulin resistance
43
What are the liver function tests that can be done and what do they indicate?
ALT, AST indicate liver cell injury or death
44
Define liver failure and hepatorenal syndrome and discuss how this occurs in the terminal stages of liver failure?
Liver failure: results when 80-90% of liver function is lost Hepatorenal syndrome: terminal stages of liver failure with ascites, includes azotemia, increased creatinine and oliguria
45
Define cholelithiasis
formation of gallstones that obstruct a bile duct
46
Explain how gallstones are formed; what precipitates from the bile to form gallstones?
Gallstone formation: caused by precipitation of bile components including cholesterol and bilirubin, crystals form into gallstones Usually cholesterol, calcium salt of bilirubin or calcium carbonate precipitate from bile
47
What is cholecystitis and the relationship to obstruction and infection.
Cholecystitis: inflammation of the gallbladder Obstruction: causes accumulation of bile in the gallbladder and increased pressure
48
How can perforation of the gallbladder result in fever, shock, and jaundice?
Causes systemic inflammatory response
49
Define/distinguish: acute and chronic pancreatitis.
Acute: reversible inflammatory process of pancreatic acini brought on by premature activation of pancreatic enzymes Chronic: progressive and permanent destruction of the exocrine pancreas, fibrosis and later stages destruction of the endocrine pancreas
50
What are major causes of acute pancreatitis (2) and how can this be life-threatening?
Causes: alcohol abuse and cholelithiasis obstruction that limits drainage of pancreatic fluid, damages multiple body systems
51
Fx of pancreatitis on GI system (2)
GI: inflammation causes premature activation of enzymes, fluid losses can lead to hypovolemic shock
52
What are underlying causes (2) of chronic pancreatitis and how can this cause type 1 diabetes?
Causes - chronic alcohol abuse, cholelithiasis Progressive loss of pancreas parenchyma leads to pathology including Type 1 diabetes
53
Where does oral cancer occur and what are risk factors?
Oral cancer: lips, pharynx, tongue, soft palate, uvula | Risk factors: tobacco/alcohol use
54
Why is the liver a common site of secondary tumors?
common site of secondary tumors as liver is responsible for blood filtration to other organs
55
Define benign vs. malignant liver tumors
Benign: liver cell adenoma, bile duct adenoma Malignant: arise from hepatocytes (hepatocellular carcinoma or hepatoma) or bile duct epithelium (cholangiocarcinoma)
56
Complications of esophageal cancer (3) and what are risk factors (3)
causes dysphagia, obstruction, usually in lower two-thirds of esophagus; causes pulmonary complications Risk factors: tobacco use, alcohol use, diet
57
Characteristics of stomach cancer (2) and what are symptoms (4)?
gastric changes, adenocarcinoma | sx: weakness, weight loss, loss of appetite, gastric pain
58
Characteristics of intestinal cancer, risk factors, sx?
adenocarcinomas, usually in large intestine risk factors: diet, other diseases Sx: rectal bleeding
59
Gallbladder cancer: Ranking in GI cancers, prognosis, sx?
5th most common GI cancer, poor prognosis 1% 5 year survival rate sx: cholecystitis
60
Pancreatic cancer: Ranking in causes of death from cancer Prognosis Are benign or malignant more common? Which is more life-threatening?
pancreatic cancer is the 4th leading cause of death from cancer in the US, 90% die within 1st year of diagnosis, 4-5% 5-year survival rate Malignant more common and more life-threatening
61
Fx of pancreatitis on cardiovascular system (2)
CV: trypsin activates kallidrein, causing vasodilation and increased vascular permeability
62
Fx of pancreatitis on clotting (2)
Clotting: pancreatic inflammation interferes with vitamin K absorption, resulting in reduced clotting factors; DIC may result
63
Fx of pancreatitis on immune system (1)
Immunity: infection of pancreas may occur and purulent drainage can erode the retroperitoneum into bowel and pleural space and promote sepsis
64
Fx of pancreatitis on respiratory system (2)
Respiratory: severe pain can interfere with breathing, resulting in PNA; pancreatic enzymes can enter circulation and damage pulmonary vessels, resulting in pleural effusion